Dilation and Curettage (D&C)

Overview

The process of Dilation and curettage (D&C) includes the removal of tissue from the uterus. This process is done to detect and treat multiple gynecological conditions, namely, excessive bleeding or to clean the uterus after an abortion or miscarriage. 

The procedure involves using specific instruments and medication to open up (dilate) the mouth of the uterus, which is called the cervix. After that, an instrument or a suction device called the curette is used to remove the tissue from the uterus. Patients are given anesthesia to handle the pain and avoid discomfort.  

Indications For D&C 

 The doctor may ask a person to undergo a D&C procedure for many reasons. They include:  

• To diagnose a condition: The procedure called endometrial biopsy is recommended if there is unusual and excessive uterine bleeding, bleeding occurring after menopause, and the presence of abnormal endometrial cells that are detected after a test for cervical cancer.  
• To treat a condition: The doctor scrapes the uterus and removes a section of tissue and the placenta to prevent infection or excessive bleeding after a miscarriage or abortion. The procedure may also help find reasons for female infertility and is carried out to remove the tumor(s)or polyps that may form, causing a condition called a molar pregnancy.  However, it may be noted that everyone who miscarries may not require a D&C. After ten weeks of pregnancy, there is a chance for an incomplete miscarriage, and the procedure helps in cleaning the uterus. 
• A D&C may be combined with a hysteroscopy and other procedures. This procedure involves inserting a slim instrument into the uterus to check for polyps and fibroid tumors.  

The Procedure     

What Happens Before The Procedure 

• The doctor enquires about the complete medical history of the person. It is crucial to inform the doctor about any allergies and medication being taken. 
• Before the procedure, the doctor may recommend medicines to soften and dilate the cervix.  
• It is essential to follow the doctor's instructions regarding the intake of food and drinks before the procedure. 

What To Expect During the Procedure  

• General anesthesia is given to the patient to put the patient to sleep and reduce the level of discomfort during the procedure. The anesthesia given may also be regional to numb the body from the waist down or local, where only the cervix becomes numb.  
• The person is asked on a table with feet in the stirrups.  
• The doctor inserts an instrument called a speculum in the vagina to help open the cervix and puts a clamp to keep it open. Dilators are used to widen the cervix gradually.  
• A curette, a spoon-shaped instrument, is used to clean the inner lining of the uterus to remove any residual or abnormally growing tissue. The tissue sample is sent to the lab after collection for further testing to detect conditions like uterine bleeding, cancer, etc.  
• The vitals of the patient are monitored throughout the procedure. 

 What To Take Care Of After The Procedure  

• The person is required to stay in the recovery room after the procedure to ensure that excessive bleeding doesn't happen or other complications don't develop. The time also helps the person to overcome the drowsiness of anesthesia.  
• The person will likely experience mild cramps and light spotting after the procedure. 
• The person can resume regular activity after a few days rest. 
• To prevent infections, the doctor may advise not to put any cream or medication in the vagina or use tampons.  
• The uterus takes time to develop a new lining; hence, the period the person may be delayed for the first time after the procedure. 
• The doctor may schedule a follow-up to discuss lab results and decide the treatment forward. 

Benefits

D&C is essential after a miscarriage or abortion to clean the uterus thoroughly to avoid excessive bleeding or infection. The procedure enables the collection of tissue samples to detect multiple gynecological issues. 

The procedure may also be an option to terminate a pregnancy after the first trimester due to various reasons. 

Risks Involved in D&C 

• Sometimes, the surgical instrument makes a hole in the uterus, causing perforation. This usually happens for women who were pregnant recently or going through menopause. Although most perforations heal independently, if a blood vessel is damaged, another procedure may be required to correct it.  
• There are chances of the cervix tearing during the procedure. This can be corrected with sutures or medicine to stop bleeding. However, softening the cervix before the procedure avoids this complication.  
• The procedure may leave scar tissues in the uterus. This condition is called Asherman's syndrome and most often happens if D7C is carried out during a miscarriage or after delivery.  
• There are chances of developing an infection in the uterus after the procedure, although the chances are meager.  

 The doctor must be contacted in case of the following symptoms after the procedure.  

•  Very heavy bleeding, usually large blood clots.  
• Dizziness or lightheadedness  
• Cramps that persist for more than two days.  
• Worsening pain in the belly.  
• Foul smell or discharge from the vagina.  
• Fever.  

Conclusion

Dilation and Curettage is a valuable procedure for removing uterine tissue and diagnosing various gynecological conditions. Getting complete information about the procedure and making informed decisions about their gynecological health is essential for the best possible outcomes.  

It is always recommended that people consult a doctor and discuss the procedure in detail, as well as the cost and any additional concerns that people may have.